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Thrombotic microangiopathy - the importance of a multidisciplinary approach
Minh-Ha Tran1, Samir Patel2, Sheetal Desai3
1University of California-Irvine, Department of Pathology-Division of Transfusion Medicine.
Insights
Establishing a multidisciplinary thrombotic microangiopathies (TMA) Team is crucial for recognizing and managing these complex disorders. A dedicated TMA Team improves patient care and facilitates research.
Area of Science:
- Hematology
- Nephrology
- Critical Care Medicine
Background:
- Thrombotic microangiopathies (TMA) are complex disorders with diverse causes spanning multiple medical specialties.
- Timely recognition and management of TMA are challenging due to their intricate nature and varied presentations.
- Hematopoietic stem cell transplant-associated TMA (TA-TMA) and associated multiorgan dysfunction syndrome (TA-TMA MODS) are active areas of research.
Conclusions:
- A multidisciplinary TMA Team enhances institutional expertise for prompt TMA recognition and management.
- TMA Teams improve diagnostic and therapeutic interventions, fostering research and clinical trial access.
- Establishing a dedicated TMA Team is vital for optimal patient outcomes and advancing TMA knowledge.
Purpose Of Review:
The purpose of this review is to highlight the importance of a multidisciplinary thrombotic microangiopathies (TMA) Team. This goal will be accomplished through review of the complement system, discuss various causes of thrombotic microangiopathies (TMA), and aspects of their diagnosis and management. In so doing, readers will gain an appreciation for the complexity of this family of disorders and realize the benefit of a dedicated multidisciplinary TMA Team.
Recent Findings:
TMA causes derive from multiple specialty areas, are difficult to timely recognize, pose complex challenges, and require multidisciplinary management. Hematopoietic stem cell transplant-associated TMA (TA-TMA) and TA-TMA related multiorgan dysfunction syndrome (TA-TMA MODS) are areas of burgeoning research; use of complement testing and eculizumab precision-dosing has been found to better suppress complement activity in TA-TMA than standard eculizumab dosing. Newer tests are available to risk-stratify obstetric patients at risk for severe pre-eclampsia, whose features resemble those of TA-TMA MODS. Numerous disorders may produce TMA-like findings, and a systematic approach aids in their identification. TMA Teams elevate institutional awareness of increasingly recognized TMAs, will help expedite diagnostic and therapeutic interventions, and create pathways to future TMA-related research and facilitate access to clinical trials.
Summary:
Establishment of a TMA-Team is valuable in developing the necessary institutional expertise needed to promptly recognize and appropriately manage patients with TMA.
